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RehabMeasures Instrument

Apathy Evaluation Scale (Self, Informant, and Clinician Versions)

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The AES addresses characteristics of goal directed behavior that reflects apathy including behavioral, cognitive, and emotional indicators.

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Instrument Details

Acronym AES




  • Brain Injury Recovery
  • Parkinson's Disease & Neurologic Rehabilitation
  • Stroke Recovery

Key Descriptions

  • 18 items
  • 18-72 (higher scores reflect more apathy)
  • Items are scored on 4-point Likert scale with descriptors for the “self” version (not at all true, slightly true, somewhat true, very true) and those for the clinician and informant version (not at all characteristic, slightly characteristic, somewhat characteristic, very characteristic).
  • Some items must be reverse scored because of the way they are written.
  • Two open questions are also asked (number of items reported, details offered in response to questions) to characterize apathy.
  • Administration instructions are provided in the Marin et al., 1991 reference; pages 161-162.

Number of Items


Time to Administer

10-20 minutes

Required Training

Training Course

Instrument Reviewers

Initially reviewed by Karen McCulloch, PT, PhD, NCS and the TBI EDGE task force of the Neurology Section of the APTA in 6/2012.

ICF Domain


Professional Association Recommendation

Recommendations for use of the instrument from the Neurology Section of the American Physical Therapy Association’s Multiple Sclerosis Taskforce (MSEDGE), Parkinson’s Taskforce (PD EDGE), Spinal Cord Injury Taskforce (PD EDGE), Stroke Taskforce (StrokEDGE), Traumatic Brain Injury Taskforce (TBI EDGE), and Vestibular Taskforce (Vestibular EDGE) are listed below. These recommendations were developed by a panel of research and clinical experts using a modified Delphi process.

For detailed information about how recommendations were made, please visit:




Highly Recommend




Reasonable to use, but limited study in target group  / Unable to Recommend


Not Recommended

Recommendations based on level of care in which the assessment is taken:


Acute Care

Inpatient Rehabilitation

Skilled Nursing Facility



Home Health







Recommendations for use based on ambulatory status after brain injury:


Completely Independent

Mildly dependant

Moderately Dependant

Severely Dependant






Recommendations for entry-level physical therapy education and use in research:


Students should learn to administer this tool? (Y/N)

Students should be exposed to tool? (Y/N)

Appropriate for use in intervention research studies? (Y/N)

Is additional research warranted for this tool (Y/N)





Not reported


Some items on the AES-I and AES-C involve judging philosophical intention (e.g. “S/he approaches life with intensity”, which may be difficult to judge as an observer. The self-rated version of the AES may be problematic if there are issues with insight into deficits as can occur with TBI.

Translated AES:

Spanish (slide 62-63):

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Brain Injury

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Cut-Off Scores

Acquired brain injury: (Andersson et al, 1999a; n=72; mean age = 30.1 (ages 16-60 years old); mean time post injury = 12.6 months ; TBI, CVA and hypoxic brain damage)

  • Score greater than 34 indicates apathy on AES-C


Traumatic brain injury: Andersson et al, 1999b (n=30; mean age = 30.1( ages 16-64); mean time post injury = 10.5 months; inpatient TBI)

  • Score greater than 34 indicates apathy on AES-C

Glenn et al, 2002 (n=46; mean age 43.1(14.9) years; mean time since injury 43.0 months; initial injury severity 52% mild, 18% moderate, 30% severe)

  • Investigators were not able to identify a reasonable cut-off score of AES-I (area under ROC curve was 0.62) or AES-S (area under ROC curve was 0.74). AES-C score of >32 had the best combination of sensitivity and specificity (area under ROC curve 0.82), with sensitivity of 95% but specificity of 0% to predict an ordinal rating of presence of behaviors that reflect apathy (a 7 point scale developed for the study).

(Lane-Brown & Tate, 2009; n=34, mean age=34.4(9.4); mean time post injury= 80.6 months; mean duration of PTA 53.2 (33.5) days)

  • Adequate diagnostic accuracy, with score greater than 36.5 resulted in ROC of .8, with sensitivity of 83% and specificity of 67%. A higher cutpoint could be used to increase specificity if desired (see Lane-Brown for values). It is likely that there is some overlap of symptoms related to fatigue and/or depression in this population that should be considered for clinical management.

Normative Data

Traumatic brain injury: (Glenn et al, 2002)

  • Mean AES-S scores  = 37 (8.6), no difference between levels of injury severity

(Kant et al, 1998; n=83; mean age 38 (12.3) years; TBI referrals to neuropsychiatric outpatient clinic)

  • Mean AES-scores = 40.5 (6.3), 71% met criteria for apathy

Internal Consistency

Acquired brain injury: (Andersson, 1999a)

  • Excellent internal consistency (Chronbach’s alpha of AES-C=.84)


TBI: (Andersson 1999b)

  • Excellent internal consistency(Chronbach’s alpha of AES-C=.89)

(Andersson & Bergedalen, 2002; n= 53; mean age = 28.3 years (2.38); mean time post injury= 12.2 months (10.6))

  • Excellent internal consistency (Chronbach’s alpha of AES-C=.87)

(Lane-Brown, 2009)

  • Excellent internal consistency (Chronbach’s alpha of AES-I= .89)

Construct Validity

Acquired BI: (Andersson et al, 1999a)

  • AES-C correlates as expected with items on depression scale (excellent levels with positive items, insignificant correlation with items reflecting depression).
  • Differentiates between hypoxia and other forms of acquired brain injury.


TBI: (Andersson et al, 1999b)

  • Significant relationships between AES-C and heart rate/blood pressure reactivity and mean arterial pressure (beta values reported, p<.01). Significant inverse relationships between AES-C and emotional discomfort.

(Andersson and Bergedalen, 2002)

  • Adequate negative correlation between AES-C and acquistion/memory (r=-.50).

(Lane-Brown, 2009)

  • Excellent correlation with the Frontal Systems Behavior Scale-Apathy items (r=.71)

Content Validity

Possible items for inclusion, described as hundreds, were gleaned from literature review and reduced via expert review based on items that were most clear and demonstrated item to total score correlations of >.4 in pilot testing. (Marin et al, 1991)

Face Validity

Face validity supported by expert review during development.

Mixed Populations

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Cut-Off Scores

Young adult controls: (Kant et al, 1998; n=108, age range 20-65 years, 94.5% in 20-49 age range, 49% male) Mean AES-S was 24.4 (4.5), therefore cutoff score of >34 indicating apathy (2 SD above mean)

Normative Data

Young adult controls: (Kant et al, 1998)

  • Mean AES-S = 24.4 (4.5)

Test/Retest Reliability

Mixed sample: (Marin 1991; n=123; aged 53-85, mixed sample of stroke, AD, depression, community dwelling well older adults)

  •  Excellent test-retest reliability (Pearson= .88 (AES-C); Pearson = .94 (AES-I); Pearson= .76 (AES-S))

Interrater/Intrarater Reliability

Mixed sample: (Marin et al, 1991)

  • Excellent interrater reliability (ICC= .94)

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Mixed sample: (Marin et al, 1991)

  • AES-C predicts average scores and time spontaneously engaged on videogame at levels of significance p<.002)

Construct Validity

Mixed sample: (Marin et al, 1991)

  • Excellent convergent validity of AES-C with other forms (r= .62-.72); Adequate discriminant validity differentiating apathy from depression and anxiety (r=.35-.39); Excellent differentiation between patients with Alzheimer’s disease, right and left hemisphere stroke and major depression (F=18.86, p<.001)

Content Validity

Possible items for inclusion, described as hundreds, were gleaned from literature review and reduced via expert review based on items that were most clear and demonstrated item to total score correlations of >.4 in pilot testing. (Marin et al, 1991)

Face Validity

Face validity supported by expert review during development.


Andersson, A. F. S. (2000). "Coping strategies in patients with acquired brain injury: relationships between coping, apathy, depression and lesion location." Brain Injury 14(10): 887-905.

Andersson, S. and Bergedalen, A. M. (2002). "Cognitive correlates of apathy in traumatic brain injury." Neuropsychiatry, Neuropsychology, and Behavioral Neurology 15(3): 184-191. Find it on PubMed

Andersson, S., Gundersen, P. M., et al. (1999). "Emotional activation during therapeutic interaction in traumatic brain injury: effect of apathy, self-awareness and implications for rehabilitation." Brain Injury 13(6): 393-404. Find it on PubMed

Andersson, S., Krogstad, J. M., et al. (1999). "Apathy and depressed mood in acquired brain damage: relationship to lesion localization and psychophysiological reactivity." Psychological Medicine 29(2): 447-456. Find it on PubMed

Clarke, D. E., Van Reekum, R., et al. (2007). "An appraisal of the psychometric properties of the Clinician version of the Apathy Evaluation Scale (AES-C)." Int J Methods Psychiatr Res 16(2): 97-110. Find it on PubMed

Glenn, M. (2005). "The Apathy Evaluation Scale." The Center for Outcome Measurement In Brain Injury.

Glenn, M. B., Burke, D. T., et al. (2002). "Cutoff score on the apathy evaluation scale in subjects with traumatic brain injury." Brain Injury 16(6): 509-516. Find it on PubMed

Kant, R., Duffy, J. D., et al. (1998). "Prevalence of apathy following head injury." Brain Injury 12(1): 87-92. Find it on PubMed

Lane-Brown, A. T. and Tate, R. L. (2009). "Measuring apathy after traumatic brain injury: Psychometric properties of the Apathy Evaluation Scale and the Frontal Systems Behavior Scale." Brain Injury 23(13-14): 999-1007. Find it on PubMed

Marin, R. S., Biedrzycki, R. C., et al. (1991). "Reliability and validity of the Apathy Evaluation Scale." Psychiatry Research 38(2): 143-162. Find it on PubMed